title: K-ras mutations and benefit from cetuximab in advanced colorectal cancer.
abstract: BACKGROUND
  Treatment with cetuximab, a monoclonal antibody directed against the epidermal growth factor receptor, improves overall and progression-free survival and preserves the quality of life in patients with colorectal cancer that has not responded to chemotherapy. The mutation status of the K-ras gene in the tumor may affect the response to cetuximab and have treatment-independent prognostic value.
  
  
  METHODS
  We analyzed tumor samples, obtained from 394 of 572 patients (68.9%) with colorectal cancer who were randomly assigned to receive cetuximab plus best supportive care or best supportive care alone, to look for activating mutations in exon 2 of the K-ras gene. We assessed whether the mutation status of the K-ras gene was associated with survival in the cetuximab and supportive-care groups.
  
  
  RESULTS
  Of the tumors evaluated for K-ras mutations, 42.3% had at least one mutation in exon 2 of the gene. The effectiveness of cetuximab was significantly associated with K-ras mutation status (P=0.01 and P<0.001 for the interaction of K-ras mutation status with overall survival and progression-free survival, respectively). In patients with wild-type K-ras tumors, treatment with cetuximab as compared with supportive care alone significantly improved overall survival (median, 9.5 vs. 4.8 months; hazard ratio for death, 0.55; 95% confidence interval [CI], 0.41 to 0.74; P<0.001) and progression-free survival (median, 3.7 months vs. 1.9 months; hazard ratio for progression or death, 0.40; 95% CI, 0.30 to 0.54; P<0.001). Among patients with mutated K-ras tumors, there was no significant difference between those who were treated with cetuximab and those who received supportive care alone with respect to overall survival (hazard ratio, 0.98; P=0.89) or progression-free survival (hazard ratio, 0.99; P=0.96). In the group of patients receiving best supportive care alone, the mutation status of the K-ras gene was not significantly associated with overall survival (hazard ratio for death, 1.01; P=0.97).
  
  
  CONCLUSIONS
  Patients with a colorectal tumor bearing mutated K-ras did not benefit from cetuximab, whereas patients with a tumor bearing wild-type K-ras did benefit from cetuximab. The mutation status of the K-ras gene had no influence on survival among patients treated with best supportive care alone. (ClinicalTrials.gov number, NCT00079066.)
authors.affiliation: Flinders Medical Centre and Flinders University, Adelaide, Australia. c.karapetis@flinders.edu.au
authors.forename: Christos S
authors.initials: CS
authors.lastname: Karapetis
authors.forename: Shirin
authors.initials: S
authors.lastname: Khambata-Ford
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Jonker
authors.forename: Chris J
authors.initials: CJ
authors.lastname: O'Callaghan
authors.forename: Dongsheng
authors.initials: D
authors.lastname: Tu
authors.forename: Niall C
authors.initials: NC
authors.lastname: Tebbutt
authors.forename: R John
authors.initials: RJ
authors.lastname: Simes
authors.forename: Haji
authors.initials: H
authors.lastname: Chalchal
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Shapiro
authors.forename: Sonia
authors.initials: S
authors.lastname: Robitaille
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Price
authors.forename: Lois
authors.initials: L
authors.lastname: Shepherd
authors.forename: Heather-Jane
authors.initials: HJ
authors.lastname: Au
authors.forename: Christiane
authors.initials: C
authors.lastname: Langer
authors.forename: Malcolm J
authors.initials: MJ
authors.lastname: Moore
authors.forename: John R
authors.initials: JR
authors.lastname: Zalcberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000068818:Cetuximab; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D004252:DNA Mutational Analysis; D018450:Disease Progression; D066246:ErbB Receptors / Q000037:antagonists & inhibitors / Q000276:immunology*; D005260:Female; D011905:Genes, ras; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009154:Mutation; D010166:Palliative Care; D011788:Quality of Life
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D066246:ErbB Receptors; D000068818:Cetuximab